Heart failure is a major cause of disability among older adults in the United States, costing approximately $28.8 billion in 2004. The majority of these costs can be attributed to HF-related activity limitations. This dissertation explored limitations in activities of daily living in community dwelling older women with HF in three studies. The first study explored the concordance of four activity assessment methods (self-report, proxy-report, clinical judgment, and performance observation in the clinic) with a criterion method (performance observation in the home) in a single sample (n = 55). Multitrait-multimethod matrix analyses revealed that the best concordance with the criterion was achieved with in-clinic performance observation, however, the concordance was marginal at best - fair for 3 activity domains (functional mobility, personal care, and cognitive instrumental activities) and poor for 1 (physical instrumental activities) domain. With the same sample, the second study examined the influence of the environment on activity performance, by performance testing the same activities in an occupational therapy clinic and in participants homes. The environment influenced the performance of daily living activities in neutral, enabling, and disabling ways, depending on whether activity independence, safety, or adequacy was being measured and whether measurement accounted for functioning at the global, domain, or individual activity level. The third study examined the trajectory of activity limitations and impairments in the same heart failure sample compared to a group of older women without disabling diseases (n = 57) over 6 months. At baseline and follow-up, the non-disabled group performed more independently and adequately than the heart failure group but equally safely. Both groups experienced a loss of independence and adequacy over time but not of safety. Physical impairment and depression emerged as the most likely candidates responsible for the group differences and changes in functioning. Findings from these studies suggest that performance observation in the home may be the most valid method of assessing disability, the influence of the environment on performance is variable, and older women with heart failure sustain greater activity limitations than those without disabling diseases but the rate of change over time is similar.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-10052005-112917 |
| Date | 13 October 2005 |
| Creators | Raina, Ketki Dhruv |
| Contributors | Adele L. Towers, Lynette Chandler, PhD, PT, Margo B. Holm, PhD, OTR/L, Joan C. Rogers, PhD, OTR/L, Stephanie A. Studenski |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-10052005-112917/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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